The above link is to an article I just read regarding the overdiagnosis of bipolar disorder in children. Written by a Dr. Kaplan (child psychiatrist), he notes that many children with ADHD or ODD have been diagnosed with bi-polar disorder due to temper tantrums, grandiosity, impulsivity, racing thoughts, elevated silliness, etc. These symptoms are really happening but Dr. Kaplan does not believe they are associated with bipolar disease (and thus not appropriate to be treated with medications like Lithium, Wellbutrin, or Depakote). Dr. Kaplan goes on to say that he thinks there isn’t any scientific evidence of bipolar beginning in childhood.

Not sure I would agree with him about this but I do agree that bipolar is an easy target when a child has frequent outbursts and is difficult to rein in. He and others are right to point out that irritability is not a good indicator of bipolar disease. Nor is emotional lability a good indicator. Many ADHD kids end up with a bipolar diagnosis when they should not have it.

What should the overdiagnosis tell us? It is not really about “big pharma” trying to drug our kids. It is not about psychiatrists just wanting to push pills. It is about overwhelmed parents and teachers who do not know what to do with the overwhelming emotional/behavioral rollercoaster some children exhibit. They (parents and kids) need help and our understanding of these issues (lability, irritability, grandiosity, tantrums, etc.) and how to best help these children are poor.

Rather than beat up on the system, let us figure out better methods to parent and counsel these types of children.

this is an area that is much more of an issue your side of the atlantic. int eh UK children under 12 are pretty much never diagnosed with bipolar. even at that age, there is often a lack of clear progression to what adult psychiatrists [like myself] recognise as bipolar. this causes a problem as the patient has been told they have bipolar, but i don’t think they are anything like the other patients with bipolar i see every day!

Sadly, the diagnosis of Bi-Polar disorder and ODD is common for children detained within the Foster Care system. Many children with “Bi-Polar” diagnosis are demonstrating symptoms of untreated trauma responses, irritability, labile mood, depression, inattentiveness, avoidance, hypervigilence, behaviors that are subjective in nature to the observer, who often does not have the child’s compete history. Tragically younger children are unable to express their fears verbally and resort to doing what has been done to them or what they have observed, erratic and chaotic behaviors demonstrated through caregiver neglect. Many of these same children also suffer the effects of substance exposure in utero which further decreases their ability to self regulate. Until we begin to view our most fragile population through the lens of trauma and/or substace exposure we will continue to misdiagnose and prolong the child’s self defeating behaviors.